What you need to know about Medicare Advantage plans

Lisa M. Davila, B.S.N., M.S.

Created date

October 22nd, 2018

Erickson Advantage plans offer many benefits to members, but you need to be an Erickson Living resident to take advantage of these services.

Medicare Advantage plans are more popular than ever. Since 2004, the number of beneficiaries enrolled in Medicare Advantage plans has more than tripled—from 5.3 million to 19 million in 2017—that’s over one-third of all Medicare beneficiaries.

Why have so many beneficiaries switched to a Medicare Advantage plan? Medicare Advantage plans may provide additional benefits beyond Original Medicare and often include prescription coverage along with medical and hospitalization benefits all in one plan.

With annual enrollment around the corner, now is the time to review your health insurance options. Considering a change for your health insurance can be confusing, but it does not need to be. Take the quiz below and get the facts to better understand Medicare Advantage plan options.

True or false: If you enroll with a Medicare Advantage plan, you must always give up some Original Medicare coverage.

False. All Medicare Advantage plans offer the same benefits as Original Medicare (Medicare Part A and Part B). Many Medicare Advantage plans include prescription coverage (Part D), and some plans may offer additional benefits and features.

For example, certain plans under Erickson Advantage—a Medicare Advantage plan exclusively for residents of Erickson Living communities—offer preventive dental services, routine podiatry care, falls prevention, and eyeglass and hearing aid coverage. In some Erickson Advantage plans, transportation to medical appointments is available (up to 12 round trips or 24 one-way trips per year to and from in-network medical appointments).

In addition, Erickson Advantage provides an on-site nurse care coordinator who assists members in navigating the health care system and offers guidance in managing their chronic illnesses and staying healthy. Member services staff is available to help schedule appointments, coordinate transportation, and answer any billing questions.

True or false: If you have a Medicare Advantage plan, you must obtain authorizations for all specialty care.

False. Medicare Advantage plans were originally structured primarily as Health Maintenance Organization (HMO) plans. The term HMO has a negative connotation for some people because of the restrictions requiring you to get authorizations from your primary doctor to see providers in or out of the plan’s network.

Today’s Medicare Advantage plans, however, can be structured in a different way. In some HMO POS (point of service) plans such as Erickson Advantage, members can receive care for specialists listed in the network without a referral. In Erickson Advantage plans, members can also receive care from out-of-network providers who accept Medicare, though higher copays may be incurred in these circumstances.

True or false: In all Medicare Advantage plans, you must have a qualifying inpatient hospital stay or else you have to pay out of pocket for care in a skilled nursing facility.

False. Many people believe this because in the current health care system, if you have Original Medicare and need to be admitted to a skilled nursing facility (SNF) after a hospitalization, you may have to pay for it out of pocket if you are not classified as a “hospital inpatient” for at least three days before going to the SNF. A SNF stay can be necessary for many reasons, including a stroke, joint replacement, chronic infection, or wound care.

In some Medicare Advantage plans, however, including Erickson Advantage, the three-day hospital inpatient stay requirement is waived. In fact, members who have a medically necessary need may go to a skilled facility even if they haven’t been admitted to a hospital in the first place. This type of benefit could potentially save you a lot of money. A 2017 Genworth Financial survey showed that in the U.S., the median cost for a 30-day skilled nursing facility stay in a semiprivate room is about $7,000.

True or false: If you are in a Medicare Advantage plan, you may experience better health outcomes.

True. A June 2018 peer-reviewed study found that, on average, when compared to fee-for-service Original Medicare beneficiaries, otherwise healthy Medicare Advantage members with hip fractures spent five fewer days in skilled nursing facilities and received 463 fewer minutes (about 7 hours less) of rehabilitation therapy. The study also found that Medicare Advantage patients were less likely to be readmitted to hospitals and less likely to become a long-term resident at a nursing home. In addition, Medicare Advantage members were more likely to stay in their communities after release from a skilled nursing facility.

How does your current plan measure up?

Erickson Advantage health resource managers are available for Erickson Living residents who would like to have a comparison review of their health insurance plan or learn more about the Erickson Advantage plan and how it works.

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare.